Provider Demographics
NPI:1508521055
Name:STOREY, JASMINE GABRIELLE (RN, CDCES)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:GABRIELLE
Last Name:STOREY
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PARKWAY S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5096
Mailing Address - Country:US
Mailing Address - Phone:864-458-4479
Mailing Address - Fax:
Practice Address - Street 1:10 PARKWAY S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5096
Practice Address - Country:US
Practice Address - Phone:864-458-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC206120163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator